Dear Doc | Can I reverse my vasectomy?

Q Dear Doc, I read your article last week about untying tubes in women. I am in my late 40s and in a new relationship with a younger woman and it is going well. She, however, does not have any children yet, and she wants to have in the future.

The problem is, I got a vasectomy after my first child. That pregnancy was an accident and, at the time, seemed like it ruined my life, so it was a rush decision to do it at that time. I have not told anybody that I did this, including the woman I'm seeing, and I would like to know if I can 'untie' mine as well.

A Very interesting. Simply because men very rarely choose this method of contraception, especially in our culture. That being said, similarly to the answer I gave last week for female sterilisation, the simple answer would be no.

It is also considered a permanent form of contraception, and is not meant to be reversed. Due to the ease of this procedure, and low risk of complications when compared to that done for females, it has a very high success rate, with a vasectomy being successful in more than 99 per cent of men.

Vasectomy reversal procedures are, however, also offered. Vasectomy reversal is called a vasovasostomy.

When a vasectomy is performed, each vas deferens (tube) is cut and cauterised (burned). Sometimes, instead of burning, it is sutured (stitched) closed. This prevents sperm from leaving the epididymis, the place where sperm is stored. After the procedure, no sperms are released from the penis at the time of ejaculation.

Similar to my answer last week regarding females, there are variations to this procedure, and these variations can affect reversal success rates.

In some procedures, a loop of vas is brought to the surface and a small segment is removed (up to about one centimetre). The two cut surfaces of the vas are then either cauterised (treated with heat), tied off, or clipped. The success rate of this procedure depends upon the condition of the vas at the time of reversal, and cauterising the vas will have resulted in more damage than if it was tied off or clipped.

The reversal procedure is a microsurgical technique that reconnects the vas deferens, and so it will also be an easier, more successful procedure if a segment of the vas was not removed.

As more time passes from the time of the vasectomy to reversal, the less likely it is to be successful. There is a 76 per cent success rate when vasectomy reversal is performed three years or less from the time of the vasectomy, compared to a 30 per cent success rate when vasectomy is done 15 years or more before reversal.

An additional consideration in vasectomy reversal is the development of sperm antibodies. Sperm antibodies develop in 40 per cent of men after a vasectomy. These are formed when leaked sperm cells interact with the body's immune system. These antibodies can make sperm cells less effective if the vasectomy is reversed.

It is best to have a discussion with the doctor who performed your vasectomy, as he would know what procedure was used, and better advise you about reversal and the possibility of its success.

I had a heatstroke

Q Dear Doc, I am very confused. I was at a health fair recently and while there, I felt very unwell and passed out. Luckily, a doctor was there and was able to attend to me quickly. He said I had a heatstroke but I would be fine, and sent me home, but with not even so much as medication. Now, I know a stroke is a serious condition; shouldn't I have been given medication and be sent to the hospital? I am feeling better, but I would like to know if I should see a specialist about my stroke.

A I can understand your confusion, but I assure you, you have nothing to be overly concerned about.

Heatstroke is a condition that can happen when a person's body gets too hot. Most often, it happens when people exercise in very hot weather without drinking enough fluids. But it can also occur when not exercising, and is especially likely to affect older people, so they need to be extra careful in hot conditions.

Contrary to the term, it is not the same as the 'stroke' that we commonly use to describe what is medically known as a cerebrovasular accident, in which the brain is affected because of a problem with blood flow.

When having a heatstroke, it is important to get medical help right away, so seeing the doctor at the health fair was very good for you. The main treatment involves cooling your body down by various methods such as:

- Spraying yourself with cool water while sitting in front of a fan.

- Move into the shade, or go into an air-conditioned area.

- Taking a cool shower or bath.

- Drink water or a sports drink.

- Take off any extra clothing you are wearing.

- Put a cold pack or cool cloth on your neck or armpit.

The most important thing is to ensure you recognise the symptoms to prevent it happening again.

You can, however, see your regular doctor, just to ensure that you do not have any other health problems that may cause you to be more likely to having a heatstroke.